Comparison of usg guided or landmark approach fascia iliaca compartment block for positioning in elderly hip fracture patients with spinal anesthesia: a randomized controlled observational study
Abstract:Background/aim
Currently, the elderly population in the world is rapidly increasing due to technological developments and convenient access to health services. Due to comorbidities in elderly patients, hip fractures are frequently observed after exposure to environmental trauma. To reduce pain during positioning in spinal anesthesia, fascia iliaca compartment block (FICB) can be applied easily and reliably.
In our study, we aimed to compare the analgesic effects and duration of fascia… Show more
“…It also reduces the risk of pneumonia, allows for quicker mobilization, and lowers costs associated with pain medication, especially with single-shot blocks [10]. Driven by concerns about opioids, particularly their risks in the elderly, pain management is undergoing a shift.…”
Hip fractures in elderly patients significantly burden health and healthcare costs. Effective pain management is crucial for optimal recovery, prompting the exploration of innovative strategies like peripheral nerve blocks (PNBs). This review investigated the clinical and economic impact of PNBs on geriatric patients undergoing hip fracture surgery. A systematic review identified relevant research on PNB use in this population, searching databases like PubMed, Cochrane, and others for studies published before September 2023. The findings revealed several potential benefits associated with PNBs, including targeted pain control, decreased opioid dependence, and facilitated earlier mobilization. Notably, the analysis highlighted a dual impact, with PNBs demonstrating potential clinical advantages like shorter hospital stays and fewer complications alongside their costs. However, the evidence of their influence on healthcare costs remains inconclusive. Despite the uncertainty surrounding cost-effectiveness, the overall trend suggests positive clinical outcomes associated with PNBs, including improved recovery and reduced opioid reliance. These potential benefits could translate to a positive impact on healthcare resource utilization.
In conclusion, PNBs show promise for improved clinical outcomes and potentially reducing healthcare resource utilization. To solidify cost-effectiveness, future studies should pinpoint economic benefits and refine PNBs use. A more thorough analysis is needed to confirm these financial advantages.
KEYWORDS: hip fracture, peripheral nerve blocks, elderly, hospitalization duration, healthcare costs.
“…It also reduces the risk of pneumonia, allows for quicker mobilization, and lowers costs associated with pain medication, especially with single-shot blocks [10]. Driven by concerns about opioids, particularly their risks in the elderly, pain management is undergoing a shift.…”
Hip fractures in elderly patients significantly burden health and healthcare costs. Effective pain management is crucial for optimal recovery, prompting the exploration of innovative strategies like peripheral nerve blocks (PNBs). This review investigated the clinical and economic impact of PNBs on geriatric patients undergoing hip fracture surgery. A systematic review identified relevant research on PNB use in this population, searching databases like PubMed, Cochrane, and others for studies published before September 2023. The findings revealed several potential benefits associated with PNBs, including targeted pain control, decreased opioid dependence, and facilitated earlier mobilization. Notably, the analysis highlighted a dual impact, with PNBs demonstrating potential clinical advantages like shorter hospital stays and fewer complications alongside their costs. However, the evidence of their influence on healthcare costs remains inconclusive. Despite the uncertainty surrounding cost-effectiveness, the overall trend suggests positive clinical outcomes associated with PNBs, including improved recovery and reduced opioid reliance. These potential benefits could translate to a positive impact on healthcare resource utilization.
In conclusion, PNBs show promise for improved clinical outcomes and potentially reducing healthcare resource utilization. To solidify cost-effectiveness, future studies should pinpoint economic benefits and refine PNBs use. A more thorough analysis is needed to confirm these financial advantages.
KEYWORDS: hip fracture, peripheral nerve blocks, elderly, hospitalization duration, healthcare costs.
ObjectiveIn this study, we aimed to observe the effects of ultrasound-guided fascia iliaca compartment block (FICB) combined with hypobaric spinal anesthesia on post-operative pain and cognitive function in elderly patients with high-risk hip replacement.MethodsA total of 84 elderly patients—aged 65–85 years, with American Society of Anesthesiologists physical status III–IV, and scheduled for hip arthroplasty between September 2021 and May 2022—were selected. One or more organs with moderate to severe impairment were included in all patients. The patients were randomly divided into a hypobaric spinal anesthesia group (group C, control group) and an ultrasound-guided FICB combined with hypobaric spinal anesthesia group (group E, experimental group). Group C was given 3.5 mL of 0.32% ropivacaine hypobaric spinal anesthesia, and group E received ultrasound-guided FICB combined with 3.5 mL of 0.32% ropivacaine hypobaric spinal anesthesia. The patients were compared using the visual analog scale (VAS) for pain, Harris hip function score, and simple Mini-Mental State Examination (MMSE) scale. Blood β-amyloid (Aβ) and neuronal microtubule-associated protein (tau) levels were measured. We compared intraoperative conditions and post-operative complications between the two groups to assess the effects of FICB combined with hypobaric spinal anesthesia on post-operative pain and cognitive function in elderly patients with high-risk hip replacement.ResultsAt 1 and 3 days after the operation, patients in group C had significantly higher VAS and lower MMES scores than those in group E. The differences were statistically significant at 1 (P < 0.01) and 3 (P < 0.05) days after the operation. At 1 day after operation, the Harris score of patients in group C was significantly lower than that of patients in group E (P < 0.05). The Aβ and tau levels of patients in group C were significantly higher than those of patients in group E at 1 day after the operation (P < 0.01). The Aβ levels of patients in group C were significantly higher than those of patients in group E at 3 days after the operation (P < 0.05). The intraoperative conditions and post-operative complication rates did not differ significantly between the two groups. At 1 day before and 5 days after the operation, there was no difference in any of the indicators.ConclusionBy lowering pain and managing Aβ and tau protein concentrations, FICB can successfully lower the incidence of early post-operative cognitive impairment in elderly patients with high-risk hip replacement.Clinical trial registrationwww.chictr.org.cn, identifier: ChiCTR2100051162.
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